Provider Demographics
NPI:1629062120
Name:LESSER, LAURENCE EDWARD (DC)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:EDWARD
Last Name:LESSER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10411 COURTHOUSE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-1798
Mailing Address - Country:US
Mailing Address - Phone:540-891-9191
Mailing Address - Fax:540-891-9225
Practice Address - Street 1:10411 COURTHOUSE RD
Practice Address - Street 2:SUITE B
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-1798
Practice Address - Country:US
Practice Address - Phone:540-891-9191
Practice Address - Fax:540-891-9225
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8940258Medicaid
258995OtherMAMSI
2069101OtherAETNA HMO
VA76579OtherSOUTHERN HEALTH INSURANCE
VA107097OtherANTHEM BC/BS
5518015OtherAETNA PPO
VA76579OtherSOUTHERN HEALTH INSURANCE
VA8940258Medicaid